Reinforced prosthetic implant with flexible shell

ABSTRACT

A fluid-filled soft prosthetic implant having a shell with a reinforced shell wall. The soft prosthetic implant may be for breast reconstruction or augmentation, or to restore the normal appearance of soft tissue in the buttocks, chin, calf, etc. The implants may be reinforced using several methods: reinforcement of the shell wall, non-homogeneous gel-filling, or both. At least a portion of the perimeter region desirably has a shell wall thickness greater than the average shell wall thickness of either the anterior face or the posterior face. The added material at the perimeter region strengthens that area in which a large percentage of implant ruptures occur. The reinforced perimeter also helps prevent the implant from collapsing or folding, which can cause undesirable rippling or wrinkling visible through the patient&#39;s skin. The remainder of the shell will desirably have a nominal wall thickness to retain the overall softness and supple feel of the implant. The implant shell may be filled with gels of different gel cohesiveness to counterbalance any reinforced area or to provide added reinforcement.

CROSS-REFERENCE

This application is a continuation of U.S. patent application Ser. No.14/088,163, filed Nov. 22, 2013, which is a divisional of U.S. patentapplication Ser. No. 12/853,003, filed Aug. 9, 2010, which claims thebenefit of U.S. Provisional Patent Application Ser. No. 61/234,751,filed Aug. 18, 2009, the entire disclosure of each of which isincorporated herein by this specific reference.

FIELD OF THE INVENTION

The present invention relates to soft, fluid-filled prosthetic implantsand, more particularly, to a fluid-filled prosthetic implant with areinforced shell.

BACKGROUND OF THE INVENTION

Implantable prostheses are commonly used to replace or augment bodytissue. In the case of breast cancer, it is sometimes necessary toremove some or all of the mammary gland and surrounding tissue thatcreates a void that can be filled with an implantable prosthesis. Theimplant serves to support surrounding tissue and to maintain theappearance of the body. The restoration of the normal appearance of thebody has an extremely beneficial psychological effect on post-operativepatients, eliminating much of the shock and depression that oftenfollows extensive surgical procedures. Implantable prostheses are alsoused more generally for restoring the normal appearance of soft tissuein various areas of the body, such as the buttocks, chin, calf, etc.

Soft implantable prostheses typically include a relatively thin andquite flexible envelope or shell made of vulcanized (cured) siliconeelastomer. The shell is filled either with a fluid such as a siliconegel or a normal saline solution. Filling of the shell takes place beforeor after the shell is inserted through an incision. The presentinvention pertains to any type of fluid-filled prosthesis, but isespecially beneficial for use with gel-filled shells.

Gel-filled breast implants have been in use for over 40 years. In the1960s, the implants were filled with a relatively thick, viscoussilicone gel which created a somewhat non-responsive, unnatural feel.The implants were mostly shaped. During the 1970s and into the 1980s, asofter, more responsive silicone gel was introduced. Some implantsincluded two lumens. Since the 1980s up to the present, improvements tothe silicone gel rendered them somewhat more cohesive and firm withoutbeing non-responsive.

Confidence in silicone-gel implants ebbed at one stage, as the U.S. Foodand Drug Administration had restricted the use of silicone gel-filledimplants in the U.S. from 1992 through late 2006 over the concern thatsilicone gel leaking into the body could be harmful. Since 1992 therehave been only two U.S. manufacturers of gel-filled breast implants,Inamed Corp. (now part of Allergan, Inc. of Irvine, Calif.) and MentorCorp. (now part of Ethicon/Johnson & Johnson, New Brunswick, N.J.).

Besides safety, another important goal is maintaining breast shape aftersurgical implantation. During post-operative follow-up—once healing hasprogressed—surgeons sometimes observe undesirable alterations in thepatient's breast shape, specifically signs of skin and/or soft tissuedeformation, commonly known to those skilled in the art as wrinkling,knuckling or scalloping. These adverse effects usually occur at theupper or lower pole of the prostheses, along the perimeter of theprosthesis shell or at the base, i.e. the inferior portion closest tothe inframammary fold, and become more evident when the recipientchanges her anatomical position. Moreover, with the patient in anupright position, these unstable prostheses have been known to collapseor fold in the upper pole and knuckle in the lower pole, furtherincreasing risk of deformed breast shape. Medical prostheses have beenproposed in an attempt to eliminate these clinical problems, such asthickened perimeter areas as in U.S. Pat. No. 6,605,116 to Falcon, etal. Indeed, some current breast implant shells feature a nominalincrease in wall thickness at the perimeter region, where the radius isthe smallest, but adverse alterations in breast shape from folding andsuch continue to be seen.

Despite attempts to eliminate cosmetic flaws in implanted breastimplants, there remains a need for an implant that more reliably retainsa natural shape.

BRIEF DESCRIPTION OF THE DRAWINGS

Features and advantages of the present invention will become appreciatedas the same become better understood with reference to thespecification, claims, and appended drawings wherein:

FIG. 1 is a cross-sectional view through a soft, fluid-filled prostheticimplant having an increased density shell and showing etched informationon an exterior label.

FIG. 2A is a rear or posterior plan view of a soft, fluid-filledprosthetic implant shell;

FIG. 2B is a front or anterior plan view of the implant shell of FIG. 2Aillustrating a series of drawn concentric bands useful for determiningwall thickness across the anterior face;

FIG. 3 is a cross-sectional view through the reinforced shell of FIG. 2Ashowing a reinforced perimeter area;

FIG. 4 is a detailed cross-sectional view of a fill opening in the shellprior to application of a patch;

FIG. 5 is a detailed cross-sectional view of the reinforced perimeterarea B from FIG. 3; and

FIG. 6 is a cross-sectional view of the reinforced perimeter area ofFIG. 5 shown flattened; and

FIG. 7 is an enlarged portion of FIG. 6 illustrating different thicknesslayers of the reinforced shell.

DETAILED DESCRIPTION

The present application provides a reinforced prosthetic implant shell.The shell is soft and flexible, and includes a fluid filling of eithersilicone gel or saline to form a soft prosthetic implant. The mostcommon type of soft prosthesis shown for illustration purposes is forbreast reconstruction or augmentation, though prostheses formed inaccordance with the teachings herein may be used to restore or augmentthe appearance of soft tissue in the buttocks, chin, calf, etc.

FIG. 1 illustrates an exemplary reinforced breast implant 20 having aflexible outer shell 22 and a fluid 24 filling an internal cavity. Inthis embodiment, a flush patch 26 covers a manufacturing hole, thoughother configurations such as a fluid-adjustment valve or other patch maybe substituted. The fluid 24 may be a gel, such as a silicone gel,saline, or other suitable fluid filler.

The breast implant 20 may be reinforced in a number of ways, the goalbeing a stronger implant that resists rupture, while also being morecosmetically acceptable. Specifically, the implants disclosed herein aredesigned to be 20% more rupture-resistant than previous shells of thistype, as measured by an ISO static rupture test. Furthermore, the shellshave been tested to be 20% stronger than prior shells based on the majorshell strength parameters of break force, tear strength and elongation.At the same time, the shells are about 20% softer from durometertesting, and have about a 50% reduction in gel permeability according tothe ASTM silicone disk method. These are performance values based on anAllergan brand Style 15 shell having a volume size of 304 cc, though theresults are considered representative for shells of similar styles andsizes. Further details on the specific tests used will be given below.

As will be explained below, the implants may be reinforced generallyusing several methods: reinforcement of the shell wall, non-homogeneousgel-filling, or both. There are a number of ways disclosed to reinforcethe shell wall, and also to selectively fill certain areas withdifferent gels, and it should be understood that the applicationcontemplates the combination of any of these possibilities.

One way to reinforce the fluid-filled, flexible shell implants is tobuild up shell wall material in strategic areas, whereas most currentshells are formed with a uniform wall thickness. More specifically forbreast implants, the shells are formed of silicone and have a generallyrounded frontal elevational shape with an oval- or teardrop-shaped(hereinafter, “generally oval”) central vertical cross-section. Theshells have an anterior or first face opposed to a posterior or secondface separated by a perimeter line. The radius of curvature of the shellas seen in vertical section is smallest at the perimeter line.

It should be noted that the shells may have either a smooth or texturedouter shell. The shell can be circular, oval, crescent-shaped or othersuitable shapes. It can be formed of silicone rubber, a laminate ofvarious forms of silicone, silicone copolymers, polyurethane, andvarious other elastomers in various combinations.

The reinforced shells disclosed herein can have an all barrier shellwith a reinforced (RF) perimeter to produce, e.g., round gel-filledbreast implants with, e.g., a smooth but matte finish exterior surface.This compares with existing smooth round breast implants currently onthe market which have the gel-diffusion inhibiting barrier layersandwiched between standard silicone layers that comprise the shell andhave a glossy exterior surface finish. The shell may be filled witheither responsive gel (Allergan TruForm I) or so-called, “Soft Touch”gel (Allergan TruForm II). The shells can be silicone gel-filled,packaged and sterilized ready for physician use. A manufacturing methodcan be a rotational casting process. This process includes making theshell in two castings. One is a regular casting of a whole shell and theother is for the reinforcement of the shell perimeter only with extrasilicone to make it stronger. The rotational shell making process andequipment to be utilized in producing the reinforced shells aredisclosed in U.S. Pat. Nos. 6,602,452 and 7,165,964. Additionally, U.S.Patent Publication No. 2009-0030515 having priority date of Jul. 27,2007 discloses a single layer all barrier material shell.

The shells disclosed herein may be reinforced by adding siliconematerial around the perimeter region relative to the first or secondfaces. In general, at least a portion of the perimeter region has ashell wall thickness greater than the average shell wall thickness ofeither the anterior face or the posterior face. The added material atthe perimeter region strengthens that area in which a large percentageof implant ruptures occur. The reinforced perimeter also may helpprevent the implant from collapsing or folding, thereby reducing thepossibility of undesirable rippling or wrinkling visible through thepatient's skin. The remainder of the shell will desirably have a nominalwall thickness to retain the overall softness and supple feel of theimplant.

FIG. 2A is a rear or posterior plan view of the soft prosthetic implantshell 22, while FIG. 3 is a horizontal cross-section through the shellwith the posterior face down and the anterior face up. In thisembodiment, the shell 22 is axi-symmetric about central axis 28, so thevertical cross-section will be the same. In other embodiments, the shell22 may have a contour, similar to a teardrop in side profile, with alarger lower lobe and thinner upper portion. Those of skill in the artwill recognize that the particular wall thickening described for theaxi-symmetric shell shown may be applied to a non axi-symmetric shell,or the increased wall thickness may be non-uniform around the shellperimeter as needed.

FIGS. 2A and 3 show the manufacturing hole 30 of the shell 22, withoutthe flush patch 26 described above. As shown in the detailed view ofFIG. 4, the manufacturing hole 30 defines a beveled edge with a smallerouter rim 32 opening to a larger inner rim 34. This shape helps matewith the flush patch 26 for a smoother final assembly.

FIG. 5 is a detailed cross-sectional view of the reinforced perimeter 40from area B shown in FIG. 3, and FIG. 6 is the same region shownflattened. The shell 22 may be segregated into three discrete geometricbands or areas, A, B and C, perpendicular to the central axis 28 as seenin FIG. 3. Area A comprises a posterior band, area B a middle band, andarea C an anterior band.

A detailed understanding of the shell geometry is necessary to specifyparticular thicknesses/ranges. The shell 22 as seen in cross-section inFIG. 3 extends from the lower manufacturing hole 30 to an upper apex 42(in this embodiment, the uppermost point on the anterior face). Theshell 22 is outwardly convex in this view, and has a maximum radiusabout the central axis 28 along a radius midpoint plane MP at aperimeter P, as seen in FIGS. 5 and 6. The radius midpoint plane MPincludes the perimeter P or generatrix at which a line TL tangent to theexterior curvature of the shell 22 parallels the central axis 28. Theperimeter P (or radius) of the shell thus defines the widest radialplane, and forms a line around the shell at the outermost diameter ofthe device as it sits posterior side down on a flat surface. Thisperimeter line separates the anterior face from the posterior face. FIG.2B shows the anterior face circumscribed by the perimeter P.

To be clear, the anterior face is the top portion of the shell (with theapex 42 as its center) extending down to the extreme outer edge orperimeter line P, while the posterior face extends around the bottomportion of the shell below the perimeter line. A perimeter region can bedefined as a region (as opposed to a line) where the anterior face andposterior face meet and containing portions of both the anterior faceand the posterior face. The present invention provides a reinforced orthickened wall portion in the perimeter region with a longitudinal axiscoincident with the central axis 28 of the perimeter P.

To define the perimeter region, certain areas may be delineated on theshell. Posterior area A extends from the manufacturing hole 30 to afirst lateral plane P1 spaced X mm axially below or in the posteriordirection from the radius midpoint plane MP. Anterior area C extendsfrom the shell apex 42 to a second lateral plane P2 spaced Y mm axiallyabove or in the anterior direction from the radius midpoint plane MP.Finally, middle area B extends between areas A and C. In a preferredconfiguration, the distance X ranges between about 2-6 mm, and thedistance Y ranges between about 7-20 mm. For instance, the distance X isabout 5 mm and the distance Y is about 10 mm.

The increased thickness of the wall of the shell 22 is seen in thedetails of FIGS. 5 and 6, and may be described relative to the areas A,B, and C. In an exemplary embodiment, the wall thickness in posteriorarea A is between about 0.013-0.040 in (0.33-1.02 mm), as measured atpoints spaced about 3-5 mm from the inner edge of the shell hole 30. Thewall thickness in middle or reinforced area B is between about0.020-0.060 in (0.51-1.52 mm), as measured at various points from firstlateral plane P1 to the second lateral plane P2. Finally, the wallthickness in anterior area C is between about 0.013-0.040 in (0.33-1.02mm), as measured at points located from about halfway between themidpoint plane MP and the apex 42 to within about 15 mm of the apex.

The nominal (non-reinforced) shell wall thickness is at least 0.254 mm(0.010 inches), and desirably about 0.456 mm (0.018 inches). The implantshell may be made by dip-forming, spray-forming, or rotational molding.The exterior may be smooth or textured.

FIG. 6 shows that a point of maximum thickness 44 desirably exists justabove, or in the anterior direction, from the midpoint plane MP. In oneexemplary form, the wall thickness gradually increases from both thefirst and second lateral planes P1, P2 toward the midpoint plane MP.Preferably, the linear distance (X+Y) between the first and secondlateral planes P1, P2 is between about 15-17 mm, and potentially up toabout 24 mm. In one embodiment, the thickness increases symmetricallytherebetween so that the point of maximum thickness 44 is equidistantfrom either lateral plane. In other words, the central portion of theregion of increased thickness is offset in an anterior direction fromthe midpoint plane MP. Of course, other configurations are possible.

It should be noted that the region of increased thickness may extendoutside of the middle area B into areas A or C, as is shown in FIG. 6.Other configurations are contemplated, and the placement of the regionof increased thickness as well as the point of maximum thickness 44 maybe altered depending on the size or shape of the particular shell, theshell material, the nominal thickness of the shell in the other areas,and other factors. It should also be noted that though the region ofincreased thickness desirably circumscribes the perimeter evenly, it mayvary around the shell, and may even be omitted in some areas.

FIG. 7 is an enlarged portion of FIG. 6 illustrating different thicknesslayers of the reinforced shell. It is important to recognize that notall of the increased thickness in the perimeter region of the shell isdeliberately formed, and some occurs as a normal consequence of thepreferred rotational molding process.

The reinforced shell is desirably made by rotational molding (as opposedto mandrel dipping). In particular, the implant shells of the presentinvention are desirably formed using a rotational molding system, suchas disclosed in U.S. Pat. Nos. 6,602,452 and 7,165,964, and U.S. PatentPublication No 2008-0181981, all to Schuessler, which are expresslyincorporated herein by this reference. Schuessler discloses a rotationalmolding machine for forming medical articles, in particular for moldingsilicone elastomer shells for breast implants.

One method of making the reinforced shell comprises introducing a smallamount of liquid silicone in a rotational mold cavity and rotating themold about only one axis (typically while heating). This creates a bandof silicone within the mold around the perimeter location. Next more (ormost) of the liquid silicone is added into the mold cavity and the moldis then rotated about two or more axes (and also typically whileheating) to thereby form the entire shell—now with a reinforcedperimeter band going all the way around the shell.

The molded shell is then cured, either before or with the application ofa patch over the mold hole. A silicone gel is then injected into theshell interior.

Three thickness layers are illustrated in FIG. 7, though it should beunderstood that the wall of the shell 22 may be homogenous incomposition, with the three layers merely representing areas wherematerial deposits during the mold process. Specifically, a first orouter layer 50 represents a first amount of shell wall material formedinto a peripheral band. A second or inner layer 52 and a third,intermediate layer 54, represents a second amount of shell wall materialforming the majority of the shell 22. That is, the preferred process forforming the shell 22 comprises first rotational casting the peripheralband 50 around a mold cavity perimeter region, and then casting theentire shell including simultaneously casting the second and thirdlayers 52, 54 within the peripheral band.

The peripheral band 50 extends an axial distance (when flattened)between posterior and anterior borders B1, B2. As mentioned above, thedistance between the first and second lateral planes P1, P2 is betweenabout 15-17 mm, and potentially up to 24 mm. However, the axial distancethe posterior and anterior borders B1, B2 of the peripheral band 50 isless than that, and preferably ranges between about 10-20 mm. The restof the thickened shell wall, represented by the intermediate layer 54,is a consequence of the rotational molding process and is formed in allshells made in this manner. Stated another way, only the first or outerlayer 50 comprises material added to a conventional rotationally moldedshell. This also means that the region of increased thickness thatextends between the first and second lateral planes P1, P2 is notentirely a “reinforced portion,” in that the intermediate layer 54 ispresent in prior shells. The reader will understand that illustration ofthe intermediate layer 54 is for convenience and comparison with theother two layers 50, 52, though the second casting of silicone materialwill build up smoothly against the interior of the mold cavity andpreformed peripheral band 50. Therefore, the extra material thataccumulates in the peripheral region cannot be pinpointed to the insideor outside of that casting, and the depiction of the intermediate layer54 on the outside is arbitrary in that respect.

To define the reinforced portion more precisely, it is limited to thearea of the shell that is less than about 0.5 inches (about 12.7 mm)from the perimeter (line at the midplane MP). A methodology of measuringthis thickness and assessing shells is important to be able to quantifywhere the reinforced area actually starts.

By definition a reinforced region will be thicker than other regions,and the thickness of any one region will be determined as an average. Itwill be understood that, as a practical matter, only a limited number ofsingle point measurements may be made to determine the average thicknessof any one region of the implant. One method used herein is to dividethe shell anterior face into concentric bands centered on the centralaxis 28, determine the average thickness of each band, determine theproportion of each band relative to the total anterior face surfacearea, and then arrive at a total average thickness for the wholeanterior face as well as the reinforced region.

First shell thickness measurements are taken from the perimeter P andevery 5 mm along a line (termed a spline) on the shell surface to theapex 42. Repeat at 90 degree intervals around the shell for a total of 4splines or sets of thickness measurements. Each 5 mm interval along thesplines then determines a band A5, A10, etc. (FIG. 2B) which in turnlocates eight thickness measurements around its borders. For instance,FIG. 2B shows eight dots located at the eight spline corners for thesecond largest band A10, which is between 5-10 mm onto the anterior facefrom the perimeter P. Thickness measurements at these eight points aretaken and their average is then an approximation of the averagethickness of the thickness of whole band A10.

The contribution of each band (A5, A10, etc.) to the total area of theanterior face depends on the size or diameter of the shell 22 which willdetermine the area of each band. Given a certain shell diameter, andassuming the anterior shell surface is flat, a weighted averagecalculation for each band's contribution to the whole shell can be done.Exemplary shell surface area calculations are shown in the table belowfor a shell having a diameter of 100 mm.

TABLE I Outer Inner Area of Band Weighted Radius Radius (mm²) = Avg Band(OR) (IR) π(OR)² − Area of ID mm mm π(IR)² Band A5 50 45 1492 19.0% A1045 40 1335 17.0% A15 40 35 1178 15.0% A20 35 30 1021 13.0% A25 30 25 86411.0% A30 25 20 707  9.0% A35 20 15 550  7.0% A40 15 10 393  5.0% A45 105 236  3.0% A50 5 0 79  1.0% Total Area of Anterior Face 7854  100%

With the relative band areas defined, measurement of band shellthickness enables an Anterior Face Average Thickness to be calculated.Several ways to measure thickness are contemplated, including anon-destructive method that produced exemplary data as follows:

TABLE II Band Average Weighted Weighted Thickness = Avg Avg Component oftwo borders Area of of Band Avg Band ID (8 total points) mm BandThickness, mm A5 0.0348 19.0% 0.0066 A10 0.0244 17.0% 0.0041 A15 0.021415.0% 0.0032 A20 0.0228 13.0% 0.0030 A25 0.0235 11.0% 0.0026 A30 0.0223 9.0% 0.0020 A35 0.0213  7.0% 0.0015 A40 0.0206  5.0% 0.0010 A45 0.0203 3.0% 0.0006 A50 0.0199  1.0% 0.0002 Total Weighted Anterior FaceAverage Thickness 0.0248

The present application desirably provides shells 22 in which bands A5and A10 are reinforced, or have a thickness greater than the averageanterior thickness, and the bands farther than 10 mm away from theperimeter P (i.e., A15, A20, etc.) have an average thickness less thanthe average anterior thickness, and are thus not part of the reinforcedregion. Stated another way, the reinformed perimetric region does notextend farther than 10 mm from the perimeter line P onto the anteriorface. Alternatively, a larger reinforced region may be provided, such asone which extends at least 50 mm from the perimetric line P, orsubstantially the entire anterior face. These exemplary dimensions forthe reinforced region may be mirrored onto the posterior face, or may belimited only to the anterior face.

Another more accurate measurement technique includes destruction of asample of shells and more data points. For instance, the measured bandincrements will be approximately every 0.050 inches, or approximately 1mm instead of 5 mm. Also, the number of splines will be increased fromfour to eight, or about every 45° around the shell. One useful method isto sample more shells using the non-destructive fewer-point measurementmodel as a screening tool. Once sufficient data is gathered, acorrelation study may be performed between the original non-destructivetests and the finer destructive model to validate the non-destructivemodel.

As mentioned above, a preferred rotational molding techniques results ina relatively smooth transition between the perimetric reinforced regionand the anterior and posterior faces. However, other configurations arepossible, which can be obtained via rotational molding or otherformation techniques. For instance, the transition between the posteriorand anterior faces may not be smooth, or the transition between thereinforced perimeter and just the anterior face may not be smooth. Oneexample of a non-smooth transition is a step between the regions whichmay be formed by placing an insert into the rotational mold. Or, themold itself may be provided with a corner or other such discontinuity toresult in a step or corner on the exterior of the shell.

Prototypes of the reinforced shells have been made with rotationalmolding with different levels of silicone material in the preferred twostep casting process; a first casting step to create a band of siliconewithin the mold around the perimeter, and a second casting step to formthe entire shell. To better determine the proper fill amounts, 76different breast implant shells were formed from 76 different siliconefirst and second dispersion fills, consisting of five separate series ofcastings of different profiles over a range of mold sizes, tabulatedbelow. The mold diameters ranged from 9.0 to 17.5 cm, though not all thetest series included all of the diameters.

One example of the two-step casting process as detailed in the first rowin Table III below (mold #1090) includes a first casting of 4.6 g of36.3% solid silicone/xylene dispersion. The operator introduces thefirst casting material into the rotational casting mold and spins themold about its central axis so that the first casting materialaccumulates around the perimeter. The operator then introduces 24.7 g ofthe second casting material (36.3% dispersion) into the mold and spinsthe mold about multiple axes so that the second casting materialsubstantially evenly covers the inside of the mold and the band of firstcasting material. Both casting steps are desirably done in conjunctionwith heating and solvent gasses are vented throughout. The first castingmay or may not be cured prior to performance of the second casting.

TABLE III Mold Single cast 1^(st) Cast- 2^(nd) Cast- Mold dia.target-35% 36.3% 36.3% 1^(st) # (cm) solid (g) solid (g) solid (g) Cast% 1090 9.0 22.4 4.6 24.7 15.7 1095 9.5 24.8 5.0 27.4 15.4 1100 10.0 27.45.4 30.2 15.2 1105 10.5 30.1 5.9 33.2 15.1 1110 11.0 32.9 6.4 36.4 15.01115 11.5 36.0 6.8 39.8 14.6 1120 12.0 39.2 7.4 43.3 14.6 1125 12.5 42.67.9 47.0 14.4 1130 13.0 46.0 8.4 50.8 14.2 1135 13.5 49.6 9.0 54.8 14.11140 14.0 53.4 9.6 59.0 14.0 1145 14.5 57.3 10.2 63.2 13.9 1150 15.061.3 10.8 67.7 13.8 1155 15.5 65.5 11.4 72.3 13.6 1160 16.0 69.8 12.177.0 13.6 1165 16.5 74.2 12.8 81.9 13.5 1170 17.0 78.8 13.5 87.0 13.41175 17.5 83.5 14.2 92.1 13.4

TABLE IV Mold Single cast 1^(st) Cast- 2^(nd) Cast- Mold dia. target-35%36.3% 36.3% 1^(st) # (cm) solid (g) solid (g) solid (g) Cast % 2090 9.022.8 5.5 25.2 17.9 2095 9.5 25.4 6.0 28.0 17.6 2100 10.0 28.0 6.6 30.917.6 2105 10.5 30.8 7.1 34.0 17.3 2110 11.0 33.7 7.7 37.2 17.1 2115 11.536.8 8.3 40.7 16.9 2120 12.0 40.1 8.9 44.3 16.7 2125 12.5 43.5 9.6 48.016.7 2130 13.0 47.1 10.2 52.0 16.4 2135 13.5 50.8 10.9 56.1 16.3 214014.0 54.6 11.6 60.3 16.1 2145 14.5 58.6 12.4 64.7 16.1 2150 15.0 62.713.1 69.2 15.9 2155 15.5 66.9 13.9 73.9 15.7 2160 16.0 71.3 14.7 78.815.7 2165 16.5 75.9 15.5 83.8 15.6 2170 17.0 80.5 16.4 88.9 15.6

TABLE V Mold Single cast 1^(st) Cast- 2^(nd) Cast- Mold dia. target-35%36.3% 36.3% 1^(st) # (cm) solid (g) solid (g) solid (g) Cast % 3090 9.023.6 6.5 26.0 20.0 3095 9.5 26.2 7.1 28.9 19.7 3100 10.0 28.9 7.7 32.019.4 3105 10.5 31.8 8.4 35.1 19.3 3110 11.0 34.9 9.1 38.5 19.2 3115 11.538.1 9.8 42.0 18.9 3120 12.0 41.5 10.5 45.8 18.7 3125 12.5 45.0 11.349.7 18.5 3130 13.0 48.7 12.1 53.7 18.4 3135 13.5 52.5 12.9 57.9 18.23140 14.0 56.4 13.7 62.3 18.0 3145 14.5 60.6 14.6 66.9 17.9 3150 15.064.8 15.4 71.5 17.7 3155 15.5 69.2 16.4 76.4 17.7 3160 16.0 73.7 17.381.4 17.5

TABLE VI Mold Single cast 1^(st) Cast- 2^(nd) Cast- Mold dia. target-35%36.3% 36.3% 1^(st) # (cm) solid (g) solid (g) solid (g) Cast % 4090 9.024.6 7.5 27.1 21.7 4095 9.5 27.3 8.2 30.1 21.4 4100 10.0 30.2 8.9 33.321.1 4105 10.5 33.2 9.7 36.7 20.9 4110 11.0 36.4 10.4 40.2 20.6 411511.5 39.7 11.3 43.9 20.5 4120 12.0 43.3 12.1 47.8 20.2 4125 12.5 46.913.0 51.8 20.1 4130 13.0 50.8 13.9 56.0 19.9 4135 13.5 54.8 14.8 60.419.7 4140 14.0 58.9 15.8 65.0 19.5 4145 14.5 63.2 16.7 69.7 19.3 415015.0 67.6 17.8 74.6 19.3 4155 15.5 72.2 18.8 79.8 19.1

TABLE VII Mold Single cast 1^(st) Cast- 2^(nd) Cast- Mold dia.target-35% 36.3% 36.3% 1^(st) # (cm) solid (g) solid (g) solid (g) Cast% 5090 9.0 27.1 8.5 29.9 22.1 5095 9.5 30.1 9.2 33.3 21.9 5100 10.0 33.310.1 36.8 21.5 5105 10.5 36.7 10.9 40.5 21.2 5110 11.0 40.2 11.8 44.421.0 5115 11.5 43.9 12.7 48.4 20.8 5120 12.0 47.8 13.7 52.7 20.6 512512.5 51.8 14.7 57.2 20.4 5130 13.0 56.1 15.7 61.9 20.2 5135 13.5 60.516.7 66.8 20.0 5140 14.0 65.0 17.8 71.8 19.9 5145 14.5 69.8 18.9 77.019.7

These masses of first and second dispersion fills presume a siliconedispersion having 36.3% solids. That is, the dispersion includes 36.3%by mass solid silicone particles and the rest a solvent, typicallyxylene. If the dispersion varies, the amounts for the first and secondcastings will also vary to ensure formation of the same thickness shellwall. The five tables show preferred results for the different moldprofiles over a range of diameters. That is, a conventional shell istypically formed with a single dispersion fill the amount of which isshown in column 3. It should be noted that the dispersion for the targetsingle casting is slightly different, 35% rather than 36.3%.

The last column indicates the ratio in percent of the firstreinforcement cast to the second shell cast. Several trends are seen.First, the percent of first-to-second castings decreases as the moldsize increases. This is because the surface area of the entire moldcavity increases at a greater rate than the perimeter region withincreasing diameter, and thus proportionally more of the second castwill be required. Secondly, as the target single cast amount increases,from Table III to Table VII, the percent of the first reinforcement castincreases for any particular mold diameter. Finally, the amount ofsilicone dispersion used in the first perimeter cast is between about13-23% in all of the examples, with the caveat that the range may changewith a different solid percent dispersion.

The reinforced prosthetic implant may also be characterized byalterations in gel filler cohesiveness. Implants having fillers ofvarying density are known in the art. For example, Allergan's Style 510Dual Gel breast implant contains two different cohesive gels. Theposterior of the implant is made from standard cohesive gel, while theanterior is made from a high cohesive gel. This configuration providessuperior projection and support, emphasizing the nipple/areola area ofthe implant.

U.S. Patent Publication No. 2007-0135916 to Maxwell, filed Oct. 25, 2006is expressly incorporated herein by this reference.

In addition to reinforcing the perimeter region, therefore, onealternative to make the implant is to cast a ring of soft gel (lesscohesive) under the radially reinforced area so that the feel of thatarea is more cosmetically acceptable. The soft filler counterbalancesthe relatively more rigid perimeter area. The remainder of the shell isfilled with a firmer gel (more cohesive) that will more effectivelymaintain the implant shape than the softer gel.

A further alternative technique to make the implant is to reinforce theradius or perimeter area by using a ring of firmer gel only around theperimeter, which will better resist deformation. The rest of the shellis filled with a softer gel. This technique can be done with or withoutalso reinforcing the shell perimeter.

Another important aspect of the present invention is that the implantdesirably utilizes a single layer all barrier shell (“ABS”). In previousimplants, the barrier layer was sandwiched between a non-barrier outerlayer and a non-barrier inner layer. The ABS layer is made of siliconein which about 15% of the molecules have phenyl substituents. Thenon-ABS layers have only about 5% phenyl substituents. Moreparticularly, the shell made of a single barrier layer. The barrierlayer is formed of a homogeneous silicone elastomer capable ofsterically retarding permeation of the silicone gel through the shelland having a bleed rate that is less than about 40% of the bleed rate ofcurrent shells which use a sandwiched construction with an internalbarrier layer. Further, the barrier layer shell is made of a materialthat exhibits a wet strength that is comparable to or greater thancurrent shells. The silicone elastomer may be a dimethyl polysiloxane,and the substituted chemical group is a diphenyl group with a minimummole percent of at least about 10%, for example, at least about 13%.Such materials have been described in Schuessler et al., U.S. PatentPublication No. 2009-0030515, the entire disclosure of which isexpressly incorporated herein by this reference.

Compression tests on these reinforced shells are on average about 20%stronger than the non-reinforced shells.

Using state-of-the-art manufacturing technology enables fabrication of anew silicone gel breast implant shell that is stronger and softer thanprior shells. The gel fill may be the same as the gel fill currentlyavailable today in the U.S. Based on independent lab testing of physicalproperties, this round, smooth breast implant shell:

-   -   a. Features a shell design with an identifiable reinforced        perimeter for 20% higher rupture resistance as measured by ISO        static rupture testing. Based on data gathered from explanted        breast implants, over half of documented ruptures occur at the        perimeter.    -   b. Has reduced gel permeability by 50% vs. the leading        competitor (Based on test method per ASTM F703:2007).    -   c. Is 20% stronger than the leading competitive shell based on        overall average shell strength measures of break force, tear        force and elongation (Uses test methods ASTM D412).    -   d. Has at least 15% less surface friction than other smooth        shells (Based on measure of static coefficient of friction as        measured per test method ASTM D1894-06).    -   e. Is 20% softer than the leading competitive shell (Based on        durometer measurements per ASTM D2240).

A reinforced shell breast implant disclosed herein may be implanted inany number of well-known methods. For instance, a number of possibleincisions used by surgeons include an inframammary incision, aperiareolar incision, and a transaxillary incision. A resilient sizermay be used to determine the size (and possibly shape) of theappropriate implant, which is then selected and prepared for implant.The surgeon collapses the breast implant, sometimes with the assistanceof a tool such as a funnel, and delivers the implant through the chosenincision. Once inserted and oriented properly, the implants resilientlyexpand back to their original forms without much if any manipulation bythe surgeon. At this point, the surgeon can finally observe and evaluatewhether the size and shape of the selected implant is appropriate forthe patient.

Although the invention has been described and illustrated with a certaindegree of particularity, it is understood that the present disclosurehas been made only by way of example, and that numerous changes in thecombination and arrangement of parts can be resorted to by those skilledin the art without departing from the scope of the invention, ashereinafter claimed.

What is claimed is:
 1. A method of making a shell for a fluid-filled prosthetic implant, comprising: providing a mold having a cavity and defining a generally oval vertical cross-section with a first face opposed to a second face and separated by a perimeter region; introducing a first quantity of silicone elastomer into the mold cavity; causing the first quantity of silicone elastomer to distribute generally evenly around the mold cavity perimeter region; allowing the first quantity of silicone elastomer to coalesce and form a perimeter ring within the mold cavity; introducing a second quantity of silicone elastomer into the mold cavity; causing the second quantity of silicone elastomer to distribute generally evenly around the entire mold cavity; curing the silicone elastomer to form a hollow implant shell; and removing the implant shell from the mold cavity.
 2. The method of claim 1, wherein the mold is part of a rotational casting machine, and the step of causing the silicone elastomer to distribute generally evenly around the mold cavity perimeter region comprises rotating the mold about only one axis.
 3. The method of claim 1, wherein the step of causing the second quantity of silicone elastomer to distribute generally evenly around the entire mold cavity comprises rotating the mold about two or more axes.
 4. The method of claim 1, wherein the first quantity of silicone elastomer is between about 13-23% of the second quantity of silicone elastomer.
 5. A method of making a gel-filled prosthetic implant, comprising: forming a hollow implant shell having a generally oval vertical cross-section with a first face opposed to a second face and separated by a perimeter region; introducing a first silicone elastomer gel into the hollow implant shell; causing the first silicone elastomer gel to distribute generally evenly around the perimeter region of the hollow implant shell; allowing the first silicone elastomer gel to coalesce and form a ring within the perimeter region of the hollow implant shell; introducing a second silicone elastomer gel into the hollow implant shell, the second silicone elastomer gel having a different softness than the first silicone elastomer gel; and removing the implant shell from the mold cavity.
 6. The method of claim 9, wherein the second silicone elastomer gel has a lesser gel cohesiveness than the first silicone elastomer gel.
 7. The method of claim 9, wherein the second silicone elastomer gel has a greater gel cohesiveness than the first silicone elastomer gel. 